- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.10 / $132.75 / $177.39
| Facility | 26 | $112.10 | $132.75 | $177.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $125.00 / $200.00
| Professional | 26 | $100.00 | $125.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $84.34 / $84.34 / $84.34
| Professional | 26 | $84.34 | $84.34 | $84.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.08 / $112.76 / $188.38
| Professional | 26 | $100.08 | $112.76 | $188.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $822.88 / $1,053.11 / $1,053.11
| Facility | 26 | $822.88 | $1,053.11 | $1,053.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.14 / $109.46 / $241.42
| Professional | 26 | $85.14 | $109.46 | $241.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.14 / $100.91 / $145.94
| Professional | 26 | $85.14 | $100.91 | $145.94 |